Medical Claims Processor

Job Description

Medical Expert/Processor - Eyther.ai Eyther.ai is going to revolutionise Revenue Cycle Management (RCM) for hospitals in India through a powerful combination of technology and operational excellence. As a technology-first company, we're solving critical challenges in the Indian healthcare claim operations, including lack of transparency, high rejection rates, and inefficient claims processing. Our mission is to transform how hospitals manage their revenue cycles, enabling them to focus on what matters most—patient care. Role Mission As a Medical Expert/Processor at Eyther.ai, you will be at the frontline of our clinical claim processing operations, applying your medical knowledge to ensure accurate and efficient claim validation. You will work within our Claim Processor structure, reviewing medical documentation, identifying potential denial flags, and ensuring claims meet both clinical and administrative requirements before submission. This role combines clinical expertise with technology-assisted workflows, allowing you to develop specialized skills at the intersection of healthcare and finance. You'll be part of a team that's transforming healthcare RCM in India, making a meaningful impact on both hospital operations and patient experience. This is an ideal role for medical professionals who are curious about how AI and technology are reshaping healthcare operations and want to develop specialized expertise in clinical documentation and claim processing. Key Responsibilities Clinical Documentation Review & Validation •Review medical documentation for completeness, accuracy, and compliance with coding guidelines •Validate clinical information against established medical necessity criteria •Identify missing or incomplete documentation that could lead to claim denials •Work with technology and check claims according to established protocols and timelines •Apply knowledge of both government schemes (PMJAY, RGHS, CGHS) and private insurance requirements •Ensure claims meet all administrative and clinical requirements •Work with Eyther.ai's AI-powered tools for claim validation and documentation review •Provide feedback on technology performance to help improve AI prediction engines •Utilize digital platforms for efficient claim processing and tracking •Adapt to new technologies and digital workflows as they are implemented •Contribute insights for technology enhancements based on day-to-day processing experience •Demonstrate curiosity and enthusiasm for how AI is reshaping medical claim processing Qualifications & Experience Required Qualifications •Medical degree (MBBS, BDS, BHMS, Ayush, or equivalent) with valid registration •0-3 years of professional experience (fresh graduates with strong academic records are welcome to apply) •Basic understanding of medical coding and clinical documentation •Strong attention to detail and analytical skills •Proficiency with computers and ability to learn new software quickly •Excellent written and verbal communication skills •Ability to work in a fast-paced, metrics-driven environment Core Competencies Clinical & Technical Knowledge •Understanding of medical terminology and clinical procedures •Ability to interpret medical documentation and treatment plans •Knowledge of basic coding principles and documentation requirements •Awareness of medical necessity criteria •Aptitude for learning technical systems and digital workflows •Curiosity about AI and technology applications in healthcare Process & Quality Focus •Strong attention to detail •Ability to follow established protocols and procedures •Commitment to accuracy and quality •Time management and productivity skills •Problem-solving and critical thinking abilities •Continuous improvement mindset Communication & Teamwork •Clear and concise communication skills •Ability to explain clinical concepts clearly •Collaborative approach to problem-solving •Receptiveness to feedback and coaching •Willingness to ask questions and seek clarification •Professional interaction with team members and stakeholders Personal Attributes •Empathy and compassion toward patients and healthcare providers •Adaptability and willingness to learn •Curiosity about healthcare technology and innovation •Resilience and ability to maintain focus in a fast-paced environment •Integrity and commitment to ethical standards •Growth mindset and eagerness to develop new skills Why Join Eyther.ai? •Develop specialised expertise at the intersection of healthcare, technology, and finance •Work with cutting-edge AI tools that are transforming healthcare operations •Clear path for growth and advancement within our tiered Claim Processor structure •Comprehensive training and continuous learning opportunities •Be part of a mission-driven team making healthcare more accessible and transparent •Collaborative and supportive work environment Eyther.ai is committed to building a diverse team that reflects the communities we serve. We encourage applications from candidates of all backgrounds and experiences. Show more Show less